Cardiology Coding Alert

Question: When our physicians perform peripheral angiograms on the lower extremities and do two different views of one vessel, such as the tibial vessel, should I charge each view with 75774? Michigan Subscriber Answer: No. Add-on code +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation) describes an additional angiogram performed from a different selective catheter position, not additional views taken with the catheter in the same position. Example: With the catheter in the distal aorta, the physician injects contrast and performs imaging over the bilateral lower extremities (75716, Angiography, extremity, bilateral, radiological supervision and interpretation). To obtain more detail in the distal lower extremity, the physician then passes the catheter down into the contralateral superficial femoral artery (36247, Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) and performs another study of the contralateral leg. You should report the additional contralateral leg study with 75774. Because 75774 is an add-on code, you must report it alongside the code for the initial angiogram. In this case, you add 75774 to 75716. The physician should document the reason the additional selective exam was necessary (for example, to better define a distal lesion). Watch for: You frequently use 75774 for studies of the visceral vessels. For example, you should report 75774 if the physician performs a celiac arteriogram (75726, Angiography, visceral, selective or supraselective [with or without flush aortogram], radiological supervision and interpretation) with the catheter in the celiac axis, and then advances the catheter into the common hepatic artery (36246, Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) and performs additional imaging.